andpresentOsteoarthritis official healthOsteoarthritis official healthcare protocolcare protocol
What is an official health care protocol? A health care protocol is designed to coordinate all the healthcareprofessionals involved in the provision of care for a patient to ensurethat patients receive the best possible treatment for their specificcondition.2• Avenir de l’Assurance Maladie: les options du Haut Conseil pour l’Avenir de l’Assurance Maladie (HCAAM)http://www.securite-sociale.fr/IMG/pdf/l_avenir_de_l_assurance_maladie_les_options_du_hcaam.pdf• Médecine de parcours: un objectif et des enjeux à confirmer. Interview with Denis Piveteau, Chairman of the Haut Conseil pour l’Avenir de l’AssuranceMaladie, Le Concours médical, June 2012 (pages 428-429). This type of official protocol is particularly useful for patients with chronicconditions requiring input from several healthcare professionals:the patients GP therefore plays a central, coordinating role. Health care protocol efficiency (in other words the best treatmentat the best price) is one of the priority focuses identified by the Haut Conseilpour lAvenir de lAssurance (National Council for the Futureof Healthcare Insurance) and is seen as a means of ensuring the continuedexistence of the healthcare system and its founding principles, especiallyequality of access to quality care and solidarity between the sickand the healthy.
An example of a conditionthat has become chronic Type 2 diabetes: the incidence of this disease is risingrapidly, hand in hand with the number of overweightand obese patients. However, when properly managed,many of the complications of type 2 diabetes canbe avoided: myocardial infarction, renal failure, blindnessand amputations, etc.3Several healthcare professionals with complementary skillsare involved caring for patients with chronic conditions:this is the patients health care protocol or pathway.
Osteoarthritis is a chronic condition As people are living longer and obesity is a growingproblem, the number of patients with osteoarthritis iscontinuously rising: 65% of people aged over 65 have radiological osteoarthritis 80% of people over the age of 80 have osteoarthritis Osteoarthritis has a negative impact on quality of lifeand could, in some cases, increase mortalityby augmenting the cardiovascular risk which is at leastpartially related to a sedentary lifestyle.4The management of osteoarthritic patients is more complicated than itappears. As the population gradually ages and the number of replacementprocedures rises, this disease places a considerable financial burdenon society as a whole.Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A0_definition.asp
The goals of treatment for patientswith osteoarthritis Limit joint stiffness. Manage pain, while reducing the long-term consumptionof NSAIDs especially. Encourage patients to take exercise adapted to theircondition. Encourage patients to maintain a healthy bodyweight. Have recourse to surgery when necessary.5Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/sommaire-arthrose.aspANSM:http://www.ansm.sante.fr/var/ansm_site/storage/original/application/257d8be960ac8372dbdc513708956d50.pdfOARSI:http://www.oarsi.org/pdfs/oarsi_recommendations_for_management_of_hip_and_knee_oa.pdf
The main healthcare providers involvedThe official treatment goals for patients with osteoarthritis clearly list the healthcare professionalsliable to become involved, the first of these being the treating physician, almost always a GP.Some specialists play an important role in caring for patients with osteoarthritis.The rheumatologist: for cases that are difficult to manage (refractory pain, extensive jointdamage), the GP may refer the patient to a rheumatologist for needle aspiration followed,in most cases, by injections of steroids or a hyaluronic acid into the joint space.An orthopaedic surgeon: when joint replacement or corrective surgery is necessary(this mainly concerns the hip or knee).The radiologist: the images obtained are used to diagnose osteoarthritis and assess the extent ofthe joint damage.An endocrinologist to provide support for patients who need to lose weight.A community pharmacist, who is trained to advise patients who have been officially diagnosedwith a chronic condition.And various other healthcare professionals, for instance:A physiotherapist: to teach patients how to move an osteoarthritic joint correctlyand to strengthen the muscles supporting the damaged joint.A nutritionist or dietician: to help overweight or obese patients.6
The GP as coordinator of the healthcare protocol7 All patients must have their own doctor; in most cases thiswill be a GP. These doctors know their patients, theirmedical history and personal situation (family, social andworking lives) best. The GP will refer his/her patients to other healthcareprofessionals for treatment (physiotherapist, dietician ornutritionist, etc.) or a specialist opinion (rheumatologist ororthopaedic surgeon, etc.)
Are tests necessary?The diagnosis of OA can usually be made on clinical grounds alone. The only tests that are essential in patients with osteoarthritis arethose allowing a precise evaluation of the structural conditionof the joints. These are standard x-rays of the joints.More sophisticated examinations, such as an MRI or CT scan,are of no use for the diagnosis of osteoarthritis and are notappropriate.8 When should these tests be done? Standard x-rays areessential during the diagnostic work-up and it is rarelynecessary to repeat them unless surgery is beingdiscussed or rapidly progressing osteoarthritis issuspected.Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/sommaire-arthrose.asp Conversely, no specific blood tests are necessary A CT or MRI scan is rarelynecessary.
9Frontal radiographs of the hips. Right supra-external hiposteoarthritis (condition); early osteoarthritis on L.
Recourse to surgery10Site de la Société Française de rhumatologie :http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/sommaire-arthrose.aspThe decision to replace a damaged joint with a prosthetic jointis no simple matter. It depends on:The impact of osteoarthritis on the patients quality of lifeFailure to derive sufficient improvement on conservativemanagement aloneThe age of the patient and his or her comorbiditiesAnd indeed, his or her life expectancyThe following are recommended before surgery:Exercises to "prepare" the muscles, tendons and ligamentsfor the roles they will have after the replacement jointhas been inserted; and to reduce joint stiffness to a minimum. And, as is the case before any surgical procedure, give up smoking whichreduces the risk of infection and improves the post-operative course.
Is hydrotherapy a legitimate partof the health care protocol for patientswith osteoarthritis? A recent study showed that hydrotherapy canimprove the painful symptoms of kneeosteoarthritis . Hydrotherapy can be beneficial by giving patientsthe chance to recommence appropriate physicalexercise, change their eating habits and losesome weight within the framework of treatmenteducation programmes. This is why hydrotherapycan be useful in the health care protocolfor patients with osteoarthritis.11